|Year : 2015 | Volume
| Issue : 1 | Page : 52-55
Biological Restoration: A Natural Replacement for a Fractured Tooth
Vivek Sunil Nair1, Niranjan Desai2, Ajit Hindlekar3, Nishant Vyavahare4, Srinidhi Surya Raghavendra5
1 Intern, Sinhgad Dental College and Hospital, Pune, Maharashtra, India
2 Reader, Department of Conservative Dentistry and Endodontics, Sinhgad Dental College and Hospital, Pune, Maharashtra, India
3 Postgraduate Student, Department of Conservative Dentistry and Endodontics, Sinhgad Dental College and Hospital, Pune, Maharashtra, India
4 Lecturer, Department of Conservative Dentistry and Endodontics, Sinhgad Dental College and Hospital, Pune, Maharashtra, India
5 Head of Department, Department of Conservative Dentistry and Endodontics, Sinhgad Dental College and Hospital, Pune, Maharashtra, India
|Date of Web Publication||19-Oct-2015|
Vivek Sunil Nair
Intern, Sinhgad Dental College and Hospital, 44/1, Vadgaon Budruk, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
Fractured anterior teeth due to traumatic injuries are a common occurrence in dental practice. The role of operative dentistry in such cases is to restore proper tooth form, function, and esthetics. Achieving this by bonding sterile dental fragments to teeth with large coronal destruction is expressed as "biological restoration." This approach provides excellent esthetics as compared to composites or cast restorations, especially in terms of translucency and is also a cost-effective alternative to the same. This paper reports the case of a 22-year-old male in whom biological restoration was considered as a biofunctional and esthetic replacement of the fractured central incisor (Ellis Class III tooth fracture) with more than 40% loss of tooth material. Following clinical and radiographic evaluation, endodontic treatment of the fractured tooth was carried out. Post space was prepared to receive the biological restoration. Extracted teeth were then used to fabricate a biological post and biological crown; which was then sterilized in accordance with biosecurity standards and later cemented. According to the available literature and clinical evidence, biological restorations can be considered as an efficient option for management of fractured anterior teeth.
Keywords: Biological restoration, post and core, tooth fracture
|How to cite this article:|
Nair VS, Desai N, Hindlekar A, Vyavahare N, Raghavendra SS. Biological Restoration: A Natural Replacement for a Fractured Tooth. J Dent Allied Sci 2015;4:52-5
|How to cite this URL:|
Nair VS, Desai N, Hindlekar A, Vyavahare N, Raghavendra SS. Biological Restoration: A Natural Replacement for a Fractured Tooth. J Dent Allied Sci [serial online] 2015 [cited 2019 Dec 15];4:52-5. Available from: http://www.jdas.in/text.asp?2015/4/1/52/167572
| Introduction|| |
Anterior tooth fractures in the maxillary arch occur quite frequently, especially in children and adolescents. They are commonly associated with oral, environmental factors, and also human nature.  A satisfactory restoration of the fractured tooth can be achieved by use of esthetic materials such as resins and porcelain. However, none of these materials completely restore the luster, surface texture or color of enamel nor do they have mechanical properties similar to enamel or dentin. In order to overcome the shortcomings of conventional esthetic materials, biological restorations that is, fragments obtained from natural teeth can be used as an alternative.
Several authors have considered natural tooth fragment reattachment as an efficient method of management of fractured teeth. ,,,, These restorations give a feel of natural teeth in the oral cavity which contributes to a higher degree of patient satisfaction  and also increases patient's self-esteem by reducing anxiety and awkwardness caused by dental trauma. This can be a feasible economical and clinically acceptable option in restorative dentistry. 
This case report presents the technique and functionality along with the pros and cons of homogenous bonding of the dental fragments and reinforcement of an extensively damaged anterior tooth with a dentin post.
| Case Report|| |
A 22-year-old male patient reported to the Department of Conservative Dentistry and Endodontics at Sinhgad Dental College and Hospital, Pune seeking management of an esthetically compromised fractured tooth [Figure 1].
He reported a fall 3 years back to be the cause of the fractured tooth. He was asymptomatic at the time of reporting and had no significant medical history. Both clinical and radiographic examination revealed that the maxillary right central incisor was fractured at the junction of the middle and cervical third of the tooth, both labially and palatally with loss of about 2/3 rd of the tooth structure.
Proposed treatment plan to restore the fractured tooth following endodontic treatment included intra radicular biological post made from an extracted and sterilized canine; as well as a crown fabricated from a previously extracted and donated tooth.
The patient was presented with the advantages and disadvantages of biological restorations along with other treatment options. It was intimated to the patient that the post and crown would be obtained from extracted natural teeth that has been sterilized keeping in mind the biosecurity standards. An informed consent was obtained on agreeing on the proposed treatment plan.
The treatment consisted of four main phases:
Phase I: Endodontic treatment of the fractured tooth.
Phase II: Post space preparation using Peeso reamers (Mani, Japan). In this step, 2/3 rd of the obturation material was removed keeping 5 mm of apical seal.
Phase III: Fabrication and cementation of the biological post.
An impression of the prepared post space along with the upper and lower arches were made using addition silicone impression material (Imprint II, 3M Deutschland GmbH, Germany) and casts were poured in dental stone [Figure 2]a and b. An acrylic resin mold was made of the post space to use as a reference to orient the thickness, shape, and length of the biological post. The donor canine and central incisors sterilized in an autoclave at 121° for 15 min under 15 lb pressure,  were selected to fabricate the post and crown respectively. Using a diamond disk the preselected canine was sectioned mesiodistally along its long axis; so as to include more of dentin in the post and prevent weakening of the post by including the root canal space. Next, using crown and bridge preparation kit (#104R, 102R Shofu Inc., Japan), biological post was shaped and all exposed canal space filled with dual-cure composite resin (Paracore, Coltène Whaledent, Altstatten, Switzerland) and polymerized (Bluephase, IvoclarVivadent, Schaan, Liechtenstein) [Figure 3]. The intra radicular post was cut and adapted on the plaster model and adaptation of the post to the prepared canal was confirmed through clinical and radiographic analyses [Figure 4]a and b.
The dual-cured resin cement was applied to the inner portion of the canal and on the surface of the post, which was then inserted into the canal under constant digital pressure until the correct length until complete polymerization of the cement.
Phase IV: Fabrication of the biological crown.
The coronal portion of the tooth was prepared to achieve a shoulder cervical margin mainly in enamel and was molded with addition silicon impression material to obtain a plaster model with a removable die. The cast along with the cast of the opposing arch was mounted on a semi adjustable articulator [Figure 5]a-c. The preselected central incisor tooth was shaped both internally as well as cervically using diamond tips until the crown adapted well to the model. To enable a good fit, cervical readaptation was done using hybrid resin composite (Tetric N-Ceram, IvoclarVivadent, Schaan, Liechtenstein) on the model. The crown was then cemented using dual-cure resin luting cement and occlusal adjustments were done after checking with articulating paper. The patient was given instructions about diet and proper oral hygiene [Figure 6].
A 6 months follow-up clinically and radiographically revealed excellent esthetics and proper adaptation of crown and post.
| Discussion|| |
The esthetic requirements in dentistry are always at its peak, which can be observed in the demands of the patient to reconstruct teeth using dental materials. Though restorative materials have evolved to a level that a "near to natural" appearance can be achieved; there is still a demand for "life-like" feel after the restoration of a fractured tooth.
In this endeavor to achieve a "life-like" feel, use of biological restorations not only return functional properties , but also esthetic properties related to form, color, translucency, surface texture, luster and natural wear and tear to the compromised dental element. Also, extensive fractures compromise the strength of the dental structures which call for reinforcement using additional forms of restorations such as resin posts, cast posts, or dentin posts (biological posts).  Cast metal posts made of titanium or steel have higher elastic modulus compared to dentin structure causing increased concentration of stresses at the tooth restoration interface which also increases chances of vertical fracture of the tooth. , Fiber posts having lower elastic modulus compared to dentin increases the risk of spontaneous debonding of the post. ,
To overcome the shortcomings of cast and resin posts, biological posts that have same mechanical properties as that of dentin can be used. , Biological posts along with the cementing medium and tooth structure form a sole biomechanical system (monoblock)  which leads to even distribution of stresses.
Biological restorations by itself do not have any contraindications except for the fact that it is difficult to find a tooth with the required characteristics (similarity of size, color, and shape). This can be easily overcome by setting up a tooth bank.  Fragment reattachment using natural teeth provides excellent results regarding surface smoothness, esthetics, and the maintenance of the incisal guide in dental structures that cause physiological wear. ,,
| Conclusion|| |
There is a requirement for further studies about the adhesion, resistance to fracture and other mechanical properties of such restorations. Long-term assessment of behavior of biological restorations needs to be established for acceptance of this technique by general dentist.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Glendor U. Aetiology and risk factors related to traumatic dental injuries - A review of the literature. Dent Traumatol 2009;25:19-31.
Reis A, Loguercio AD, Kraul A, Matson E. Reattachment of fractured teeth: A review of literature regarding techniques and materials. Oper Dent 2004;29:226-33.
Baratieri LN, Ritter AV, Monteiro Júnior S, de Mello Filho JC. Tooth fragment reattachment: An alternative for restoration of fractured anterior teeth. Pract Periodontics Aesthet Dent 1998;10:115-25.
Reis A, Loguercio AD. Tooth fragment reattachment: Current treatment concepts. Pract Proced Aesthet Dent 2004;16:739-40.
Arhun N, Ungor M. Re-attachment of a fractured tooth: A case report. Dent Traumatol 2007;23:322-6.
Busato AL, Loguercio AD, Barbosa AN, Sanseverino Mdo C, Macedo RP, Baldissera RA. Biological restorations using tooth fragments. Am J Dent 1998;11:46-9.
Yilmaz Y, Zehir C, Eyuboglu O, Belduz N. Evaluation of success in the reattachment of coronal fractures. Dent Traumatol 2008;24:151-8.
Demarco FF, de Moura FR, Tarquinio SB, Lima FG. Reattachment using a fragment from an extracted tooth to treat complicated coronal fracture. Dent Traumatol 2008;24:257-61.
Imparato JC. Banks of Human Teeth. Curitiba: Editora Maio; 2003. p. 190.
Aguiar KC, Nascimento TN, Corona SA, Dibb RG. Homogeneous bonding, alternative technique for anterior teeth fracture. Rev Gaucha Odontol 2000;48:153-4.
Andreasen FM, Norén JG, Andreasen JO, Engelhardtsen S, Lindh-Strömberg U. Long-term survival of fragment bonding in the treatment of fractured crowns: A multicenter clinical study. Quintessence Int 1995;26:669-81.
Oz IA, Haytaç MC, Toroglu MS. Multidisciplinary approach to the rehabilitation of a crown-root fracture with original fragment for immediate esthetics: A case report with 4-year follow-up. Dent Traumatol 2006;22:48-52.
Isidor F, Odman P, Brøndum K. Intermittent loading of teeth restored using prefabricated carbon fiber posts. Int J Prosthodont 1996;9:131-6.
Meira JB, Espósito CO, Quitero MF, Poiate IA, Pfeifer CS, Tanaka CB, et al.
Elastic modulus of posts and the risk of root fracture. Dent Traumatol 2009;25:394-8.
Mannocci F, Ferrari M, Watson TF. Intermittent loading of teeth restored using quartz fiber, carbon-quartz fiber, and zirconium dioxide ceramic root canal posts. J Adhes Dent 1999;1:153-8.
Kaizer OB, Bonfante G, Pereira Filho LD, Cardinal L, Reis KR. Utilization of biological posts to reconstruct weakened roots. Rev Gaucha Odontol 2008;56:7-13.
Tay FR, Pashley DH. Monoblocks in root canals: A hypothetical or a tangible goal. J Endod 2007;33:391-8.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]